What Is the Product? (1/28/14)

Art can imitate life. Better, it can educate life. Perhaps it might perform that role for the American “health care industry.”

Whose main product is – more of itself. To reform it properly will require far more than the bizarre tinkering of the Affordable Care Act. We will need to get from yes to “No.”

“No”

Most political films are not intentionally funny. The Chilean movie “No” is a fine exception.

It describes the Chilean plebiscite of 1988 through the eyes of a super-adman played by Gael Garcia Bernal. The military dictatorship of Augusto Pinochet, helped into power by the CIA in 1973, has been ruling the country for 15 years. A plebiscite will be held. Voting yes means eight more years of dictatorship and military rule. Voting no means that Pinochet leaves – and is replaced by an elected assembly and president.

The opposition is allowed 27 days of national television exposure – for all of 15 minutes. The Pinochet regime gets the other 23 hours and forty five minutes of the day. Much of the opposition believes the election will be fraudulent. They are sure Pinochet will never leave.

But others believe democracy can win – with the right campaign. They recruit Garcia Bernal, who in turn recruits more media experts.

One of his friends makes it clear that no one can know he is involved with the “No” campaign. He doesn’t want to join the list of thousands of people murdered by the regime, or the hundreds of thousands imprisoned or exiled. His question is simple – “What is the product?”

Many of the opposition leaders say they must describe the violent brutality of the Pinochet government. But the adman answers his own question. The product – “it’s happiness. Freedom.”

With that goal, democracy can win.

Many opposition leaders hate the newly created 15 minute segments – for them, deaths and sacrifice are replaced by “a Coca-Cola commercial.” But Garcia Bernal’s team produces songs and skits that humorously ridicule the regime. Their jingle sings “Chile, happiness is coming.”

Garcia Bernal’s life is threatened. He is told to fear for the future of his child. Homes are smashed. Everyone knows what usually happens next. But the opposition wins. Chile again becomes a free democracy. Today it’s newly re-elected president is a pediatrician whose father was an Air Force general who fought Pinochet. She grew up in exile. Her losing opponent is the daughter of an Air Force general who supported the regime. As kids they lived in the same barracks.

So what is the product of American health care?

Health

What is American health care for? Is it for the profits of large pharmaceutical companies, who make most of their money in the US? Is it to ensure the continued “healthiness” of health insurance companies? Is it to augment the 18% of GDP we spend on health care, making us uneconomic with our rivals?

The answer of the World Health Organization – and most developed countries – is that health care should be organized to improve health – the physical, mental, and social well-being of the population. Economists look at “hard numbers” – like length of life and infant mortality.

According to the CIA, we rank 50th in the world in mortality; somewhere in the 40s in infant mortality. Yet longer life and healthier babies are not the only advantages of a healthy population.

People who feel well work harder. They have greater faith in the future. They feel more secure.

Contrast that with American experience. Even multi-millionaires don’t think they’ll have enough money to pay for their future health costs. When a visit to the ER for a cut finger costs $8,000, they’re right. When many new cancer medications are priced at more than $100,000 per year, they’re right. No wonder people think they will need to work till they drop to pay for health care premiums.

Most of the world has long used different health care solutions. Their health care systems are nationalized, regionally distributed, focused on producing value for money. Nobody gets a blank check.

Their governments also recognize the key economic costs of health: that addiction is terribly expensive; that kids weaned on junk food are sicker and less economically productive; that green spaces lead to longer lived populations, as do mass transit systems where people need to walk; that heavy industrial pollution leads to transiently higher profits but bigger clean up and health care costs long term.

So it’s time for Americans to recognize that health and health care are often at best tangentially related. And to ask our health care companies what they really contribute to health – our national physical, mental, social, even spiritual well-being.